ORIGINAL RESEARCH article
Front. Oncol.
Sec. Head and Neck Cancer
This article is part of the Research TopicMolecular Testing and Prognostication in Head and Neck CancerView all articles
Mandibular Preservation vs. Sacrifice Following Neoadjuvant Immunotherapy in Locally Advanced Oral Cancer: A Comparative Study of Surgical and Quality-of-Life Outcomes
Provisionally accepted
Qiongqiong Yu
Zhenjie Guan*- Zhengzhou University, Zhengzhou, China
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Objective: This study compared surgical complication, quality of life (QoL), functional recovery, and oncologic outcomes between mandibular preservation (MP) and mandibular sacrificing (MS) procedures in patients with locally advanced oral squamous cell carcinoma (OSCC) abutting the mandible who achieved a radiologic complete response (rCR) following neoadjuvant immunotherapy (NAT). Methods: A retrospective cohort study was conducted on 78 patients who achieved a primary site rCR post-NAT. Patients were allocated to an MP cohort (n=42) or an MS cohort (n=36) based on the definitive surgery performed. Primary outcomes were major complications (Clavien-Dindo ≥III) and longitudinal QoL (EORTC QLQ-C30/H&N35). Secondary outcomes included functional recovery and 3-year oncologic survival. Results: The MP cohort experienced significantly fewer major complications than the MS cohort (2.4% vs. 19.4%, p=0.013), a finding that held in multivariable analysis (aOR: 3.85, p=0.008). The MP cohort also demonstrated a significantly shorter median hospital stay (9 vs. 16 days, p<0.001), lower rates of gastrostomy dependence at discharge (28.6% vs. 63.9%, p=0.002) and at 3 months (0% vs. 11.1%, p=0.037), and superior QoL scores across multiple domains from 6 months onwards. With a median follow-up of 3 years, there were no significant differences in local (p=0.534), regional (p=0.305), or disease-free survival (p=0.332) between the cohorts. Conclusion: For select patients with OSCC achieving rCR after NAT, a mandibular preservation strategy is associated with significantly less postoperative complication, improved functional recovery and quality of life, while not compromising short-term oncologic control in this cohort. These findings suggest the feasibility of challenging the paradigm of mandatory mandibular sacrifice in exceptional responders, pending further prospective validation.
Keywords: Mandibular Preservation, neoadjuvant immunotherapy, oral squamous cell carcinoma, Quality of Life, surgical de-escalation
Received: 26 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Yu and Guan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenjie Guan
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